Explaining PD psychosis, agonist ICD risk, and treatment choices to a spouse — CASC communication station

Open. Acknowledge fear and financial trauma: "Seeing people that are not there, and the gambling, would frighten any family. You are right to want answers." [1][2]

Explain psychosis. "This pattern is often called Parkinson disease psychosis. Many people see people or animals, especially later in the day. It is a known complication of the disease and its treatments — it does not automatically mean lifelong schizophrenia." [1]

Explain ICD. "Dopamine agonist tablets such as pramipexole can, in some people, drive impulse control problems — gambling, shopping, or sexual behaviour changes. Reducing or stopping that agonist carefully with the neurology team is a key step, with safeguards around money." [2]

About stopping everything. "We will review and simplify medicines with neurology. But stopping all Parkinson medicines suddenly is unsafe — he could become very stiff, immobile, or swallow poorly. Changes must be planned." [5]

About antipsychotics. "Some strong dopamine-blocking medicines like haloperidol can make Parkinson stiffness much worse — we avoid those. If hallucinations remain dangerous after medicine review, options with better PD evidence include very low-dose clozapine (different doses than schizophrenia, but blood tests are essential for safety) or, where available, pimavanserin, which works on serotonin pathways rather than blocking dopamine the same way." [3][4]

Home tonight. "Going home depends on safety, settling of risk, and a clear plan — not only preference. We want neurology and mental health follow-up, and a plan if hallucinations or gambling urges return." [1][5]

Close. Summarise, invite questions, offer written information, introduce neurology contact, document. [5]